A Mother-Instruction Program: Documenting Change in Mother-Child Interactions
Kate L. Kogan, Ph.D.* University o f Washington School o f Medicine
Betty N. Gordon University o f Washington School o f Medicine
A B S T R A C T : Measures of mother-child interaction change are reported in a series of 30 mothers and their children, aged 2 to 10. Videotaped play sessions were analyzed in detail to provide baseline measures from which individualized modification guidelines were derived. Mothers were instru.cted in eight weekly sessions via bug-in-the-ear. Postinstruction observations provided quantification of observed changes following instruction. The target of change was motherchild behavior contingency patterns, effected by intervening into the mother component on those patterns. Measured changes in mother and child behaviors, mother-child contingency patterns, and mothers' perceptions of child behaviors are compared.
While the clinicians who apply behavior therapy to the t r e a t m e n t of childhood behavior disturbances range widely in their approach and emphasis, they share some c o m m o n assumptions and concerns. Among them are that the child's behavior is largely under the control of his immediate social environment rather than internal psychodynamic processes [1], that the everyday practical realities of family life are an important focus for therapeutic intervention, and that therapy is geared to a greater or lesser extent toward equipping parents with the theory and techniques necessary to enable t h e m to solve future problems, and thus has preventive implications. Parents are not merely the recipients of therapy but have become involved as therapists for their own children. *Dr. Kogan is in the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195. This study was supported by grant 19642 from the National Institute of Mental Health. The authors acknowledge with gratitude the collaboration of Herbert C. Wimberger, M.D., in the preliminary stages of this research, Child Psychiatry and Human Development
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Research in the area of training parents as therapists has been reviewed by Berkowitz and Graziano [2]. They conclude that while there is ample evidence that the parent-training approach is efficient and desirable, the literature suffers in general from a lack of methodological sophistication. In particular, inadequate controls, limited follow-ups, poor evaluative techniques, and lack of details of training methods and parent-child behavior changes are cited. The research program we have carried out has attempted to answer some of these methodological questions. Most studies in this area, while varying in the extent of parental involvement, focus largely on selected, discrete child behaviors or target behaviors that are either extinguished or reinforced. For example, in some studies, parents function as technicians in carrying out professionally designed and directed programs of operant conditioning [3, 4, 5, 6]. At the other extreme, parents are involved as experimenters and are responsible for observing their children's behavior and designing their own programs of behavior change [7, 8]. Patterson and his colleagues have attempted to involve n o t only parents but entire families and school personnel in the belief that lasting behavior change must be based on reprogramming as much of the child's social environment as possible and in recognition of the notion that changes in one person's behavior have effects on other members of the family system [1, 9, 10, 11]. The work of Hanf and Kling [12] and Bernal and his associates [13, 14] represents an important shift away from the concept of discrete target behaviors to the concept of the parent-child interaction system as the basis for training parents to cope with disturbing behaviors and to prevent future interpersonal disturbance. The research presented here focuses on the interpersonal context of behavior as the target of modification. In other words, the behavior of one member of an interacting pair is always viewed as relative to that of the other member rather than as a single, isolated behavior on the part of either one of them. Any change that occurs following therapeutic intervention is also assessed in terms of the behavior contingencies between the two members of the pair. Communications theorists suggest that communication of new information is only a minor part of interpersonal transactions, and the remainder is a repetitive structuring and defining of relationship [15]. Many child development theorists agree that there are observed regularities in parent-child interaction [16], and that "children are less affected by isolated episodes than by pervasive and continuing trends in parental attitudes" [17]. By applying a detailed examination of
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the behavior of each mother-child pair studied, the repetitive patterns t h a t c h a r a c t e r i z e t h e p a i r a r e d i s t i l l e d o u t . O u r c o n c e r n is t h e n t o help mothers broaden and enrich their interactions with their children by teaching them alternative kinds of interchange. T h i s r e p o r t will b e d e v o t e d t o d e s c r i b i n g a n d d e f i n i n g t h e o b s e r v e d b e h a v i o r c o n t i n g e n c i e s c h a r a c t e r i s t i c o f m o t h e r s a n d t h e i r c h i l d r e n in t w o visits b e f o r e a s e r i e s o f i n s t r u c t i o n s e s s i o n s w a s i n s t i t u t e d a n d c h a n g e s in t h e s e c h a r a c t e r i s t i c s f o l l o w i n g i n s t r u c t i o n . I n a d d i t i o n , i t will describe mothers' reports of their children's behavior at the beg i n n i n g a n d t h e e n d o f t h e s t u d y . W h i l e t h e i n s t r u c t i o n s e s s i o n s will be described briefly, a detailed analysis of them will be the subject of another report. Method
Subjects The subjects were 30 children and their mothers who were referred to the research by a professional from whom the parent had sought advice with respect to some behavior on the part of the child that was a matter of concern. The majority of the referrals were from the staff of Group Health Cooperative of Puget Sound; a few were from University of Washington affiliated sources. In each instance the mother initiated the contact, and following an interview was given the opportunity to request acceptance as a research subject. Thirty-four women committed themselves to the program; only four dropped out during the course of the sessions. The composition of the group can be identified as follows: There were 21 boys and 9 girls. Three children were 2 to 3 years of age, 14 were 4 to 5 years old, 10 were 6 to 8 years old, and 3 were 9 or 10. Social class covered the entire range, according to the Hollingshead Two Factor Index of Social Position [ 18], and fell into the following distribution: Social Class 1, 7 families; Class 2, 3 families; Class 3, 11 families; Class 4, 6 families; and Class 5, 3 families. Four of the children were only children, 15 were oldest, 5 were youngest, and 6 were middle children.
Procedures Observations were made of each mother-child pair at three points in time. Two sessions were recorded a week apart for all pairs following initial contact (Time 1). For half the group these were followed by eight weekly instruction sessions at the end of which two more sessions were recorded (Time 2). These were followed by eight weeks of no contact with the family and then by two more sessions again, a week apart (Time 3). In the other half there was no contact with the family in the eight-week interval between Time 1 and Time 2, and the instruction sessions took place between Time 2 and Time 3. The entire series thus extended over 22 weeks for all subjects. The changes discussed in this report
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deal only with the comparison of sessions immediately before and immediately after the series of instructions. Results relevant to the issue of spontaneous change during no-contact periods are the subject of a future report. In each observation session the mother and child were provided with several selections of toys and were videotaped through a one-way window. Time signals superimposed on the tape every four seconds permitted analysis of the rate and duration of separate behaviors and served as the unit of analysis in later data processing. Interactions were recorded for 42 minutes at each of the six sessions, yielding a total behavior sample of 4,780 recorded 4-second time intervals for each mother-child pair. Mother and child received separate ratings for each interval. A complete rating included assignment of values on three parameters: relative status (sometimes referred to by others as dominance-submission); affection (warmth-hostility or acceptance-rejection are close synonyms); and involvement. High status ratings were accorded to behaviors that exerted control (gave an order, repositioned the child, or prohibited), exhibited expertise (taught, explained, or demonstrated), or displayed assertiveness (contradicted, interrupted, or restrained). Low status was rated for acknowledging or soliciting control, being deferential, or recognizing the other's leadership or expertise. High affection ratings were given for exhibiting or seeking warmth, friendliness, or personal consideration, and negative affect was rated for their opposites. Each of these parameters was rated on a seven-point scale, with four being the neutral point. Involvement ratings assessed the extent to which one person's attention was focused or directed toward the other; involvement was rated on a four-point scale. Continuous weekly rater agreement checks were made throughout the data-processing period, and average agreement levels of 86, 96, and 99 percent were maintained by a variety of raters. The goal of the assessment was to delineate the unique interaction style of each dyad, to identify their deviant or excessi:~e interpersonal behaviors, and to utilize this information in modifying their interactions. A behavior frequency was defined as being deviant or extreme by comparing it with the range of frequencies exhibited by the members of the original 35 comparison mother-child dyads whose records were accumulated in previous pilot studies. When extreme or deviant elements had been identified according to the procedures just described, specific suggestions for alternate behaviors were outlined for the mother to try to follow during instruction sessions. The goals of the instruction were discussed with her, and were reviewed at the beginning of each instruction session. Suggested interactions were based on combinations already demonstrated to be in the pair's repertoire. The use of the bug-in-the-ear permitted the observer who was watching and listening to the ongoing interaction through the one-way mirror to provide specific guidance to the mother while she was engaged in interaction, by acknowledging occasions when she made the desired response, suggesting opportunities for making other responses, and calling to her attention absence of certain responses. A variety of techniques encouraged rehearsal of the desired responses outside of the laboratory. In a short interview each week the goals of the training were reviewed and clarified, and opportunities for using the same procedures at home in daily routines were discussed. The mother's specific "rules" were summarized in written form, and she was urged to teach them to her husband and/or other household people who regularly spent time with the child. Excerpts from the recorded videotapes were saved and reviewed with the mother at appropriate times.
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Results
Observed Behaviors at Initial C o n t a c t
Each set of baseline behavior observations was converted to foursecond status-affect-involvement ratings according to the procedures described above. Tabulated ratings for each mother-child pair were compared with the f r equency range of the ratings derived from 35 subjects in earlier pilot studies. Ten f r e que nc y measures were examined for each m o t h e r and child (four levels of status ratings, four levels o f affect ratings, and two levels of involvement ratings). A measure was defined as being extreme if its frequency was as high as or higher than the highest five f r equency scores of the comparison group or if it was as low as or lower than the lowest five f r e q u e n c y scores of the comparison group. The 30 mothers ranged in their total n u m b e r of e x t r e m e measures from 1 to 7, with a mean occurrence of 4.47. Of the 30 mothers, 19 evidenced high occurrence of high status ratings, and 26 evidenced low occurrence of neutral or low status ratings. T w e n t y - t h r e e of the mothers showed excessively high occurrence of neutral affect and low occurrence of m oder a t e l y positive affect ratings. In terms of involvement, the mothers were either excessively uninvolved (9 of 30) or overinvolved with their children (12 of 30). In other words, the mothers as a group could be characterized as differing from the comparison subjects by more often taking control of transactions with their children, displaying flat affect at the expense of friendly warmth, and being either underinvolved or overinvolved with their children. The children, on the whole, differed f r om the comparison population in ways that paralleled and resembled their mothers. T h e y evidenced excessive occurrence of moderate and high status behaviors (19 of 30 children), i nf r e que nt occurrence of neutral or low status behaviors (15 o f 30 children), excessive frequencies of neutral affect (18 Children), and a lack of m ode r at el y positive affective behaviors (17 children). Unlike their mothers' mixed involvement, the children tended to deviate from the comparison group in the direction of greater f r eq u en cy of active involvement (11 children). The 30 children ranged in their " t o t a l deviance" scores from 0 to 7, with a mean of 3.37. Thus, as a group, mothers and children appeared to display parallel kinds of behavior distortions, though the mothers exhibited ext rem e scores more often than the children did (t -- 2.39, p < .05). Inspec-
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tion suggests that the difference in a m o u n t was m ost p r o m i n e n t with respect to affect and involvement ratings.
Mothers" Reports of Child Behaviors prior to Instruction At her first visit each m o t h e r com pl e t e d a modification of the Washington S y m p t o m Checklist [ 1 9 ] , which required her to indicate which o f 67 described behaviors she felt her child exhibited more than most children his age, which a b o u t the same as m ost children his age, and which less than most. The n u m b e r of behaviors marked as being deviant (not " a b o u t the same as m o s t " ) ranged from 2 to 29, with the mean n u m b e r being marked 18.7. Those behavior items t hat were identified by half or more of the mothers at the beginning of the research as being present more frequently than in most children of the same age were: is stubborn, angers easily, demands a great deal of attention, is resentful of discipline, has tantrums, shows jealousy, talks back to parents, is overactive.
Mother and Child Behavior Changes following Intervention Since each mo th e r 's instructions were tailored to the specific guidelines established as a result of her initial recorded interactions with her child, behavior change had to be measured for individual cases. The measures examined for change were the 10 measures of m o t h e r behavior and the 10 measures of child behavior t hat served to identify behavior extremes at the beginning of the study, as described in the first section of these results. Each subject's frequencies for a single measure at each of the three points in time were submitted to analysis of variance. The changes r e por t ed here represent a significant difference (at, or below, the .01 level of probability) between behavior frequencies immediately before instruction began and immediately after instruction was completed. In addition, behavior rating frequencies that fell in the deviant range with respect to the comparison group immediately prior to instruction and had moved to within normal range by postinstruction were considered to have changed. Table I lists the n u m b e r of mothers and children who showed changes in each of the behavior rating categories. This tabulation demonstrates th at of a total of 300 behavior measures mothers had been able to change the rate of occurrence of roughly 35 percent following the m o t h e r instruction series, and t hat their efforts were reflected in accompanying child behavior change a little less than half as m u ch (15 percent). At the beginning, mothers had significantly
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Table 1 Behavior Rating Changes Following Instruction Mothers
Children
8
Low Status
II
13
Neutral Status
5
8
Moderately High Status
4
I__55
Extremely High Status
6
44
Total Status Changes
26
lO
Negative Affect
1
lO
Neutral Affect
4
I0
Moderately Positive Affect
7
I._99
Strongly Positive Affect
_If
49
Total Affect Changes
13
B
Passive Involvement
S
5
Non-involvement
2
13
Total Involvement Changes
7
106
Total Behavior Changes
46
more ex tr eme scores than did the children; at the end, t h e y had significantly fewer (t = 2.61, p < .02). The average for the m o t h e r s at the end was significantly less than their f r e q u e n c y at the beginning (t = 5.63, p < .01). In other words, the program, which was focused on changing m o t h e r behaviors by direct instruction, did in fact change the rate of occurrence of a considerable n u m b e r of their behaviors. Finally, it was instructive to isolate the specific behavior qualities in which most subjects exhibited change as a result of the experiences. Direct and explicit expression of warmth (affect scale values 6 and 7) was modified by 19 mothers; imposing strong c o n t r o l (status
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scale values 6 and 7) was modified by 15; sustaining equal or neutral status with their children (status scale value 4) was modified by 13. Dependency and low status (status scale values 1, 2, and 3) was modified by 11 children; the incidence of change in all other behavior categories was less than those listed.
Changes in Mother-Child Behavior Contingencies Contingency linkage between mother and child behavior ratings was calculated by chi-square on the basis of which ratings occurred together in the same four-second time unit significantly more often than their separate rates of occurrence would lead one to expect. A contingency pattern was regarded as having " c h a n g e d " if there was significant joint occurrence of a mother behavior and a child behavior either before or after instruction and n o t at the other time. Since the number of significant contingency patterns differed from one dyad to another, change was best represented by calculating the percentage of each dyad's total number of patterns that changed over the eight-week time interval during which they participated in instruction sessions. Figure 1 compares the proportion of mother-child pairs exhibiting the stated percentage amounts of change in each of the three behavior change indicators that have been discussed. Changes in mother and child behaviors, which have already been reported, are expressed here in percentage terms to make the results comparable to the chosen measure for dyad contingency changes. The figure clearly demonstrates that on the whole it was the relatedness of mother and child behaviors that was most modified following intervention procedures, rather than the absolute changes of specific behaviors on the part of either mother or child. Specifically, the three contingency patterns whose change was c o m m o n to the largest number of dyads were: competitiveness (simultaneous high status in mother and child) in 18 dyads; m o t h e r dominance (mother strong control together with child low status) in 15; and child dominance (mother low status together with child strong control) in 13.
Mothers' Reports of Child Behaviors following Intervention Sessions After final baseline behavior observations had been made, each mother again completed the Washington S y m p t o m Checklist, usually 22 weeks after she had originally filled it out. The number of deviant
Kate L. Kogan and Betty N. Gordon
01-100 01-90 71,00 61-70 51-60 41-50 31-40 21-30 11-20 0-10
197
q
I
J
I
/,,
J
a,,
0
10
2O
30
40
50
60
70
80
90
lO0
Nether-child centin|encies mother kohviors e-,..e child behaviors FIGURE 1: Cumulative proportion of dyads exhibiting stated amounts of change (percent).
behaviors reported ranged from 1 to 29, with a mean of 10.8 (Time 1 mean was 18.7). Thus, on the average, mothers perceived their children as having reduced their numbers of deviant behaviors by about 43 percent, or by about eight items. However, the changes in individual mothers ranged from one who saw 21 fewer areas of deviant behavior to one who reported 6 more areas of deviant behavior at the end of the series than at the beginning. Of the eight behavior items that were reported as problems by more than half the mothers at the beginning, the following reductions were noted: is.stubborn, reduced 36 percent; angers easily, 53 percent; demands a great deal of attention, 47 percent; is resentful of discipline, 47 percent; has tantrums, 67 percent; shows jealousy, 47 percent; talks back to parents, 60 percent; is overactive, 47 percent.
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Correlations between Mother Behavior Change, Child Behavior Change, Contingency Pattern Change, and Reduction in Problems Checked Analysis of the above results made apparent to us t hat behavior change can be viewed in a variety of ways, and that different subjects might manifest change through different avenues. The relationship between the f o u r types of change defined in this research was calculated. Table 2 shows the Pearson p r o d u c t - m o m e n t correlations between the f o u r measures of change. The results indicated t hat the various avenues of change were n o t related with the except i on of a significant negative correlation between reduction in the n u m b e r of problems checked and the a m o u n t of m o t h e r behavior change (r = = - . 4 7 ) and the a m o u n t of child behavior change (r = - . 5 2 ) . Discussion The purpose of the present study was to teach m ot hers to alter their interactions with their children, and to specify and quantify the success with which m o t h e r and child behaviors were modified as a result o f the particular instruction techniques utilized. The behaviors under examination were defined in strictly interpersonal terms, Mother-child contingency patterns were our primary targets, and we chose to intervene directly into the m o t h e r c o m p o n e n t of those patterns. According to the goals, as stated, definite changes were demons t r a t e d - g r e a t e s t of all in mother-child patterns, least in measured child behaviors.
Table 2
Correlations Between Four I~easures of Change Mother Behavior Child Behavior Contingency Patterns Problems Checked
.24 -.lO -.47 (p.OOg)
Child
Contingency Patterns
Behavior .
.
.
.
.26
--
-.52 (p.O04)
-.25
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These findings may appear paradoxical, since the mothers had sought help because they were concerned about some aspect of their child's behavior. However, in terms of interactions, one must bear in mind that it was the mothers who were uncomfortable. Furthermore, in baseline observations at the outset of the study, mothers displayed a greater number of extreme or deviant behaviors than the children did. In another population, in which specific child behaviors brought the children more blatantly into conflict with society, the methods described here might be less appropriate, and it might be more important to change child behaviors directly. There was considerable variation in the amounts of change exhibited by different mother-child pairs. Correlations between the different change measures indicated that those dyads in which motherchild contingency patterns showed greatest change were n o t necessarily the same pairs in which mothers or children exhibited the greatest number of behavior changes. It appears that quantitative change in the total a m o u n t of certain behaviors is different from and unrelated to modification in the interpersonal context in which those behaviors occur, and that these kinds of change may occur singly or simultaneously. The negative correlations between problems checked and amounts of mother or child behavior change suggest that important questions for further consideration revolve around the theme " T o what extent do these kinds of coaching in interactive techniques contribute mainly to objective behavior changes, and to what e x t e n t do they mainly influence attitude change?" The present results suggest that the changes are more likely to be evidenced in one or the other sphere--more rarely in both. Under what circumstances might both behavior and attitude change occur? Is it possible that with greater time intervals changes might be reflected in both? The present data do not provide definitive answers. In their review, Berkowitz and Graziano [2: p. 315] point out the methodological weaknesses of the various studies they have summarized and suggest additional areas in need of investigation. Two of those areas are especially pertinent to the present report and to application of its methodology in projected studies. They speak of the need for " t h e development of more precise and meaningful measures of parental and child behavior change in the broader sense o f attitudinal and interactional variables." These are the issues to which the present study is addressed. They also suggest the need for " f u r t h e r development and validation of a 'family systems' framework of therapeutic intervention" The present authors and their colleagues have begun exploration studies in the effectiveness of the interaction as-
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sessment techniques used here, to problems of family interaction and family therapy. References 1. Patterson GR: Behavioral intervention procedures in the classroom and in the home. In AE Bergin and SL Garfield (Eds), Handbook o f Psychotherapy and Behavior Change. New York, John Wiley & Sons, 1971. 2. Berkowitz B, Graziano A: Training parents as behavior therapists: A review. Behav Res Ther 10:297-317, 1972. 3. Hawkins RP, Peterson RF, Schweid EI, et al: Behavior therapy in the home: Amelioration of problem parent-child relations with the parent in a therapeutic role. J Exp Child Psychol 4:99-107, 1966. 4. Herbert EW, Baer DM: Training parents as behavior modifiers: Self-rewarding of contingent attention. J A p p l Behav Anal 5:139-49, 1972. 5. Johnson SM, Brown RA: Producing behavior change in parents of disturbed children. J Child Psychol Psychiat 10:107-21, 1969. 6. Zeilberger J, Sampen SE, Sloane HN: Modification of a child's problem behaviors in the home with the mother as therapist. J A p p l Behav Anal 1:4753, 1968. 7. Hall RV, Axelrod S, Tyler L, et al: Modification of behavior problems in the home with a parent as observer and experimenter. J A p p l Behav Anal 5:53-64, 1972. 8. Veenstra MS: Behavior modification in the home with the mother as the experimenter: The effect of differential reinforcement on sibling negative response rates. Child Dev 42: 2079-83, 1971. 9. Patterson GR, Gullion ME: Living with Children: New Methods for Parents and Teachers. Champaign, Illinois: Research Press, 1968. 10. Patterson GR: Families: Application o f Social Learning to Family Life. Champaign, Illinois: Research Press, 1971. 11. Patterson G, McNeal S, Hawkins N, et al: Reprogramming the social environment. J Child Psychol Psychiat 8:181-95, 1967. 12. Hanf C, Kling J: Facilitating parent child interaction: A two stage training model. Unpublished manuscript, 1974. 13. Bernal M, Duryse JS, Pruett HL, et al: Behavior modification and the brat syndrome. J Consult Clin Psychol 32:447-55, 1968. 14. Bernal M: Behavioral feedback in the modification of brat behaviors. J Nerv Ment Dis 148:375-85, 1969. 15. Watzlawick P, Beavin JH, Jackson DD: Pragmatics o f Human Communication. New York, Basic Books, 1967. 16. Bronfenbrenner U: Toward a theoretical model for the analysis of parentchild relationships in a social context. In J Glidewell (Ed), Parental Attitudes and Child Behavior. Springfield, Ill, Charles C Thomas, 1961. 17. Loevinger J, Sweet B: Construction of a test of mothers' attitudes. In J Glidewell (Ed), Parental Attitudes and Child Behavior. Springfield, Ill, Charles C Thomas, 1961. 18. Hollingshead AB: Two factor index of social position. Mimeographed, 1957. 19. Wimberger HC, Gregory RJ: A behavior checklist for use in child psychiatry clinics. J A m e r Acad Child Psychiat 1:677-88, 1968.
Kate L. Kogan, Ph.D.* University o f Washington School o f Medicine
Betty N. Gordon University o f Washington School o f Medicine
A B S T R A C T : Measures of mother-child interaction change are reported in a series of 30 mothers and their children, aged 2 to 10. Videotaped play sessions were analyzed in detail to provide baseline measures from which individualized modification guidelines were derived. Mothers were instru.cted in eight weekly sessions via bug-in-the-ear. Postinstruction observations provided quantification of observed changes following instruction. The target of change was motherchild behavior contingency patterns, effected by intervening into the mother component on those patterns. Measured changes in mother and child behaviors, mother-child contingency patterns, and mothers' perceptions of child behaviors are compared.
While the clinicians who apply behavior therapy to the t r e a t m e n t of childhood behavior disturbances range widely in their approach and emphasis, they share some c o m m o n assumptions and concerns. Among them are that the child's behavior is largely under the control of his immediate social environment rather than internal psychodynamic processes [1], that the everyday practical realities of family life are an important focus for therapeutic intervention, and that therapy is geared to a greater or lesser extent toward equipping parents with the theory and techniques necessary to enable t h e m to solve future problems, and thus has preventive implications. Parents are not merely the recipients of therapy but have become involved as therapists for their own children. *Dr. Kogan is in the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195. This study was supported by grant 19642 from the National Institute of Mental Health. The authors acknowledge with gratitude the collaboration of Herbert C. Wimberger, M.D., in the preliminary stages of this research, Child Psychiatry and Human Development
Vol. 5(3), Spring 1975
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Research in the area of training parents as therapists has been reviewed by Berkowitz and Graziano [2]. They conclude that while there is ample evidence that the parent-training approach is efficient and desirable, the literature suffers in general from a lack of methodological sophistication. In particular, inadequate controls, limited follow-ups, poor evaluative techniques, and lack of details of training methods and parent-child behavior changes are cited. The research program we have carried out has attempted to answer some of these methodological questions. Most studies in this area, while varying in the extent of parental involvement, focus largely on selected, discrete child behaviors or target behaviors that are either extinguished or reinforced. For example, in some studies, parents function as technicians in carrying out professionally designed and directed programs of operant conditioning [3, 4, 5, 6]. At the other extreme, parents are involved as experimenters and are responsible for observing their children's behavior and designing their own programs of behavior change [7, 8]. Patterson and his colleagues have attempted to involve n o t only parents but entire families and school personnel in the belief that lasting behavior change must be based on reprogramming as much of the child's social environment as possible and in recognition of the notion that changes in one person's behavior have effects on other members of the family system [1, 9, 10, 11]. The work of Hanf and Kling [12] and Bernal and his associates [13, 14] represents an important shift away from the concept of discrete target behaviors to the concept of the parent-child interaction system as the basis for training parents to cope with disturbing behaviors and to prevent future interpersonal disturbance. The research presented here focuses on the interpersonal context of behavior as the target of modification. In other words, the behavior of one member of an interacting pair is always viewed as relative to that of the other member rather than as a single, isolated behavior on the part of either one of them. Any change that occurs following therapeutic intervention is also assessed in terms of the behavior contingencies between the two members of the pair. Communications theorists suggest that communication of new information is only a minor part of interpersonal transactions, and the remainder is a repetitive structuring and defining of relationship [15]. Many child development theorists agree that there are observed regularities in parent-child interaction [16], and that "children are less affected by isolated episodes than by pervasive and continuing trends in parental attitudes" [17]. By applying a detailed examination of
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the behavior of each mother-child pair studied, the repetitive patterns t h a t c h a r a c t e r i z e t h e p a i r a r e d i s t i l l e d o u t . O u r c o n c e r n is t h e n t o help mothers broaden and enrich their interactions with their children by teaching them alternative kinds of interchange. T h i s r e p o r t will b e d e v o t e d t o d e s c r i b i n g a n d d e f i n i n g t h e o b s e r v e d b e h a v i o r c o n t i n g e n c i e s c h a r a c t e r i s t i c o f m o t h e r s a n d t h e i r c h i l d r e n in t w o visits b e f o r e a s e r i e s o f i n s t r u c t i o n s e s s i o n s w a s i n s t i t u t e d a n d c h a n g e s in t h e s e c h a r a c t e r i s t i c s f o l l o w i n g i n s t r u c t i o n . I n a d d i t i o n , i t will describe mothers' reports of their children's behavior at the beg i n n i n g a n d t h e e n d o f t h e s t u d y . W h i l e t h e i n s t r u c t i o n s e s s i o n s will be described briefly, a detailed analysis of them will be the subject of another report. Method
Subjects The subjects were 30 children and their mothers who were referred to the research by a professional from whom the parent had sought advice with respect to some behavior on the part of the child that was a matter of concern. The majority of the referrals were from the staff of Group Health Cooperative of Puget Sound; a few were from University of Washington affiliated sources. In each instance the mother initiated the contact, and following an interview was given the opportunity to request acceptance as a research subject. Thirty-four women committed themselves to the program; only four dropped out during the course of the sessions. The composition of the group can be identified as follows: There were 21 boys and 9 girls. Three children were 2 to 3 years of age, 14 were 4 to 5 years old, 10 were 6 to 8 years old, and 3 were 9 or 10. Social class covered the entire range, according to the Hollingshead Two Factor Index of Social Position [ 18], and fell into the following distribution: Social Class 1, 7 families; Class 2, 3 families; Class 3, 11 families; Class 4, 6 families; and Class 5, 3 families. Four of the children were only children, 15 were oldest, 5 were youngest, and 6 were middle children.
Procedures Observations were made of each mother-child pair at three points in time. Two sessions were recorded a week apart for all pairs following initial contact (Time 1). For half the group these were followed by eight weekly instruction sessions at the end of which two more sessions were recorded (Time 2). These were followed by eight weeks of no contact with the family and then by two more sessions again, a week apart (Time 3). In the other half there was no contact with the family in the eight-week interval between Time 1 and Time 2, and the instruction sessions took place between Time 2 and Time 3. The entire series thus extended over 22 weeks for all subjects. The changes discussed in this report
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deal only with the comparison of sessions immediately before and immediately after the series of instructions. Results relevant to the issue of spontaneous change during no-contact periods are the subject of a future report. In each observation session the mother and child were provided with several selections of toys and were videotaped through a one-way window. Time signals superimposed on the tape every four seconds permitted analysis of the rate and duration of separate behaviors and served as the unit of analysis in later data processing. Interactions were recorded for 42 minutes at each of the six sessions, yielding a total behavior sample of 4,780 recorded 4-second time intervals for each mother-child pair. Mother and child received separate ratings for each interval. A complete rating included assignment of values on three parameters: relative status (sometimes referred to by others as dominance-submission); affection (warmth-hostility or acceptance-rejection are close synonyms); and involvement. High status ratings were accorded to behaviors that exerted control (gave an order, repositioned the child, or prohibited), exhibited expertise (taught, explained, or demonstrated), or displayed assertiveness (contradicted, interrupted, or restrained). Low status was rated for acknowledging or soliciting control, being deferential, or recognizing the other's leadership or expertise. High affection ratings were given for exhibiting or seeking warmth, friendliness, or personal consideration, and negative affect was rated for their opposites. Each of these parameters was rated on a seven-point scale, with four being the neutral point. Involvement ratings assessed the extent to which one person's attention was focused or directed toward the other; involvement was rated on a four-point scale. Continuous weekly rater agreement checks were made throughout the data-processing period, and average agreement levels of 86, 96, and 99 percent were maintained by a variety of raters. The goal of the assessment was to delineate the unique interaction style of each dyad, to identify their deviant or excessi:~e interpersonal behaviors, and to utilize this information in modifying their interactions. A behavior frequency was defined as being deviant or extreme by comparing it with the range of frequencies exhibited by the members of the original 35 comparison mother-child dyads whose records were accumulated in previous pilot studies. When extreme or deviant elements had been identified according to the procedures just described, specific suggestions for alternate behaviors were outlined for the mother to try to follow during instruction sessions. The goals of the instruction were discussed with her, and were reviewed at the beginning of each instruction session. Suggested interactions were based on combinations already demonstrated to be in the pair's repertoire. The use of the bug-in-the-ear permitted the observer who was watching and listening to the ongoing interaction through the one-way mirror to provide specific guidance to the mother while she was engaged in interaction, by acknowledging occasions when she made the desired response, suggesting opportunities for making other responses, and calling to her attention absence of certain responses. A variety of techniques encouraged rehearsal of the desired responses outside of the laboratory. In a short interview each week the goals of the training were reviewed and clarified, and opportunities for using the same procedures at home in daily routines were discussed. The mother's specific "rules" were summarized in written form, and she was urged to teach them to her husband and/or other household people who regularly spent time with the child. Excerpts from the recorded videotapes were saved and reviewed with the mother at appropriate times.
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Results
Observed Behaviors at Initial C o n t a c t
Each set of baseline behavior observations was converted to foursecond status-affect-involvement ratings according to the procedures described above. Tabulated ratings for each mother-child pair were compared with the f r equency range of the ratings derived from 35 subjects in earlier pilot studies. Ten f r e que nc y measures were examined for each m o t h e r and child (four levels of status ratings, four levels o f affect ratings, and two levels of involvement ratings). A measure was defined as being extreme if its frequency was as high as or higher than the highest five f r equency scores of the comparison group or if it was as low as or lower than the lowest five f r e q u e n c y scores of the comparison group. The 30 mothers ranged in their total n u m b e r of e x t r e m e measures from 1 to 7, with a mean occurrence of 4.47. Of the 30 mothers, 19 evidenced high occurrence of high status ratings, and 26 evidenced low occurrence of neutral or low status ratings. T w e n t y - t h r e e of the mothers showed excessively high occurrence of neutral affect and low occurrence of m oder a t e l y positive affect ratings. In terms of involvement, the mothers were either excessively uninvolved (9 of 30) or overinvolved with their children (12 of 30). In other words, the mothers as a group could be characterized as differing from the comparison subjects by more often taking control of transactions with their children, displaying flat affect at the expense of friendly warmth, and being either underinvolved or overinvolved with their children. The children, on the whole, differed f r om the comparison population in ways that paralleled and resembled their mothers. T h e y evidenced excessive occurrence of moderate and high status behaviors (19 of 30 children), i nf r e que nt occurrence of neutral or low status behaviors (15 o f 30 children), excessive frequencies of neutral affect (18 Children), and a lack of m ode r at el y positive affective behaviors (17 children). Unlike their mothers' mixed involvement, the children tended to deviate from the comparison group in the direction of greater f r eq u en cy of active involvement (11 children). The 30 children ranged in their " t o t a l deviance" scores from 0 to 7, with a mean of 3.37. Thus, as a group, mothers and children appeared to display parallel kinds of behavior distortions, though the mothers exhibited ext rem e scores more often than the children did (t -- 2.39, p < .05). Inspec-
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tion suggests that the difference in a m o u n t was m ost p r o m i n e n t with respect to affect and involvement ratings.
Mothers" Reports of Child Behaviors prior to Instruction At her first visit each m o t h e r com pl e t e d a modification of the Washington S y m p t o m Checklist [ 1 9 ] , which required her to indicate which o f 67 described behaviors she felt her child exhibited more than most children his age, which a b o u t the same as m ost children his age, and which less than most. The n u m b e r of behaviors marked as being deviant (not " a b o u t the same as m o s t " ) ranged from 2 to 29, with the mean n u m b e r being marked 18.7. Those behavior items t hat were identified by half or more of the mothers at the beginning of the research as being present more frequently than in most children of the same age were: is stubborn, angers easily, demands a great deal of attention, is resentful of discipline, has tantrums, shows jealousy, talks back to parents, is overactive.
Mother and Child Behavior Changes following Intervention Since each mo th e r 's instructions were tailored to the specific guidelines established as a result of her initial recorded interactions with her child, behavior change had to be measured for individual cases. The measures examined for change were the 10 measures of m o t h e r behavior and the 10 measures of child behavior t hat served to identify behavior extremes at the beginning of the study, as described in the first section of these results. Each subject's frequencies for a single measure at each of the three points in time were submitted to analysis of variance. The changes r e por t ed here represent a significant difference (at, or below, the .01 level of probability) between behavior frequencies immediately before instruction began and immediately after instruction was completed. In addition, behavior rating frequencies that fell in the deviant range with respect to the comparison group immediately prior to instruction and had moved to within normal range by postinstruction were considered to have changed. Table I lists the n u m b e r of mothers and children who showed changes in each of the behavior rating categories. This tabulation demonstrates th at of a total of 300 behavior measures mothers had been able to change the rate of occurrence of roughly 35 percent following the m o t h e r instruction series, and t hat their efforts were reflected in accompanying child behavior change a little less than half as m u ch (15 percent). At the beginning, mothers had significantly
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Table 1 Behavior Rating Changes Following Instruction Mothers
Children
8
Low Status
II
13
Neutral Status
5
8
Moderately High Status
4
I__55
Extremely High Status
6
44
Total Status Changes
26
lO
Negative Affect
1
lO
Neutral Affect
4
I0
Moderately Positive Affect
7
I._99
Strongly Positive Affect
_If
49
Total Affect Changes
13
B
Passive Involvement
S
5
Non-involvement
2
13
Total Involvement Changes
7
106
Total Behavior Changes
46
more ex tr eme scores than did the children; at the end, t h e y had significantly fewer (t = 2.61, p < .02). The average for the m o t h e r s at the end was significantly less than their f r e q u e n c y at the beginning (t = 5.63, p < .01). In other words, the program, which was focused on changing m o t h e r behaviors by direct instruction, did in fact change the rate of occurrence of a considerable n u m b e r of their behaviors. Finally, it was instructive to isolate the specific behavior qualities in which most subjects exhibited change as a result of the experiences. Direct and explicit expression of warmth (affect scale values 6 and 7) was modified by 19 mothers; imposing strong c o n t r o l (status
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scale values 6 and 7) was modified by 15; sustaining equal or neutral status with their children (status scale value 4) was modified by 13. Dependency and low status (status scale values 1, 2, and 3) was modified by 11 children; the incidence of change in all other behavior categories was less than those listed.
Changes in Mother-Child Behavior Contingencies Contingency linkage between mother and child behavior ratings was calculated by chi-square on the basis of which ratings occurred together in the same four-second time unit significantly more often than their separate rates of occurrence would lead one to expect. A contingency pattern was regarded as having " c h a n g e d " if there was significant joint occurrence of a mother behavior and a child behavior either before or after instruction and n o t at the other time. Since the number of significant contingency patterns differed from one dyad to another, change was best represented by calculating the percentage of each dyad's total number of patterns that changed over the eight-week time interval during which they participated in instruction sessions. Figure 1 compares the proportion of mother-child pairs exhibiting the stated percentage amounts of change in each of the three behavior change indicators that have been discussed. Changes in mother and child behaviors, which have already been reported, are expressed here in percentage terms to make the results comparable to the chosen measure for dyad contingency changes. The figure clearly demonstrates that on the whole it was the relatedness of mother and child behaviors that was most modified following intervention procedures, rather than the absolute changes of specific behaviors on the part of either mother or child. Specifically, the three contingency patterns whose change was c o m m o n to the largest number of dyads were: competitiveness (simultaneous high status in mother and child) in 18 dyads; m o t h e r dominance (mother strong control together with child low status) in 15; and child dominance (mother low status together with child strong control) in 13.
Mothers' Reports of Child Behaviors following Intervention Sessions After final baseline behavior observations had been made, each mother again completed the Washington S y m p t o m Checklist, usually 22 weeks after she had originally filled it out. The number of deviant
Kate L. Kogan and Betty N. Gordon
01-100 01-90 71,00 61-70 51-60 41-50 31-40 21-30 11-20 0-10
197
q
I
J
I
/,,
J
a,,
0
10
2O
30
40
50
60
70
80
90
lO0
Nether-child centin|encies mother kohviors e-,..e child behaviors FIGURE 1: Cumulative proportion of dyads exhibiting stated amounts of change (percent).
behaviors reported ranged from 1 to 29, with a mean of 10.8 (Time 1 mean was 18.7). Thus, on the average, mothers perceived their children as having reduced their numbers of deviant behaviors by about 43 percent, or by about eight items. However, the changes in individual mothers ranged from one who saw 21 fewer areas of deviant behavior to one who reported 6 more areas of deviant behavior at the end of the series than at the beginning. Of the eight behavior items that were reported as problems by more than half the mothers at the beginning, the following reductions were noted: is.stubborn, reduced 36 percent; angers easily, 53 percent; demands a great deal of attention, 47 percent; is resentful of discipline, 47 percent; has tantrums, 67 percent; shows jealousy, 47 percent; talks back to parents, 60 percent; is overactive, 47 percent.
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Correlations between Mother Behavior Change, Child Behavior Change, Contingency Pattern Change, and Reduction in Problems Checked Analysis of the above results made apparent to us t hat behavior change can be viewed in a variety of ways, and that different subjects might manifest change through different avenues. The relationship between the f o u r types of change defined in this research was calculated. Table 2 shows the Pearson p r o d u c t - m o m e n t correlations between the f o u r measures of change. The results indicated t hat the various avenues of change were n o t related with the except i on of a significant negative correlation between reduction in the n u m b e r of problems checked and the a m o u n t of m o t h e r behavior change (r = = - . 4 7 ) and the a m o u n t of child behavior change (r = - . 5 2 ) . Discussion The purpose of the present study was to teach m ot hers to alter their interactions with their children, and to specify and quantify the success with which m o t h e r and child behaviors were modified as a result o f the particular instruction techniques utilized. The behaviors under examination were defined in strictly interpersonal terms, Mother-child contingency patterns were our primary targets, and we chose to intervene directly into the m o t h e r c o m p o n e n t of those patterns. According to the goals, as stated, definite changes were demons t r a t e d - g r e a t e s t of all in mother-child patterns, least in measured child behaviors.
Table 2
Correlations Between Four I~easures of Change Mother Behavior Child Behavior Contingency Patterns Problems Checked
.24 -.lO -.47 (p.OOg)
Child
Contingency Patterns
Behavior .
.
.
.
.26
--
-.52 (p.O04)
-.25
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These findings may appear paradoxical, since the mothers had sought help because they were concerned about some aspect of their child's behavior. However, in terms of interactions, one must bear in mind that it was the mothers who were uncomfortable. Furthermore, in baseline observations at the outset of the study, mothers displayed a greater number of extreme or deviant behaviors than the children did. In another population, in which specific child behaviors brought the children more blatantly into conflict with society, the methods described here might be less appropriate, and it might be more important to change child behaviors directly. There was considerable variation in the amounts of change exhibited by different mother-child pairs. Correlations between the different change measures indicated that those dyads in which motherchild contingency patterns showed greatest change were n o t necessarily the same pairs in which mothers or children exhibited the greatest number of behavior changes. It appears that quantitative change in the total a m o u n t of certain behaviors is different from and unrelated to modification in the interpersonal context in which those behaviors occur, and that these kinds of change may occur singly or simultaneously. The negative correlations between problems checked and amounts of mother or child behavior change suggest that important questions for further consideration revolve around the theme " T o what extent do these kinds of coaching in interactive techniques contribute mainly to objective behavior changes, and to what e x t e n t do they mainly influence attitude change?" The present results suggest that the changes are more likely to be evidenced in one or the other sphere--more rarely in both. Under what circumstances might both behavior and attitude change occur? Is it possible that with greater time intervals changes might be reflected in both? The present data do not provide definitive answers. In their review, Berkowitz and Graziano [2: p. 315] point out the methodological weaknesses of the various studies they have summarized and suggest additional areas in need of investigation. Two of those areas are especially pertinent to the present report and to application of its methodology in projected studies. They speak of the need for " t h e development of more precise and meaningful measures of parental and child behavior change in the broader sense o f attitudinal and interactional variables." These are the issues to which the present study is addressed. They also suggest the need for " f u r t h e r development and validation of a 'family systems' framework of therapeutic intervention" The present authors and their colleagues have begun exploration studies in the effectiveness of the interaction as-
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sessment techniques used here, to problems of family interaction and family therapy. References 1. Patterson GR: Behavioral intervention procedures in the classroom and in the home. In AE Bergin and SL Garfield (Eds), Handbook o f Psychotherapy and Behavior Change. New York, John Wiley & Sons, 1971. 2. Berkowitz B, Graziano A: Training parents as behavior therapists: A review. Behav Res Ther 10:297-317, 1972. 3. Hawkins RP, Peterson RF, Schweid EI, et al: Behavior therapy in the home: Amelioration of problem parent-child relations with the parent in a therapeutic role. J Exp Child Psychol 4:99-107, 1966. 4. Herbert EW, Baer DM: Training parents as behavior modifiers: Self-rewarding of contingent attention. J A p p l Behav Anal 5:139-49, 1972. 5. Johnson SM, Brown RA: Producing behavior change in parents of disturbed children. J Child Psychol Psychiat 10:107-21, 1969. 6. Zeilberger J, Sampen SE, Sloane HN: Modification of a child's problem behaviors in the home with the mother as therapist. J A p p l Behav Anal 1:4753, 1968. 7. Hall RV, Axelrod S, Tyler L, et al: Modification of behavior problems in the home with a parent as observer and experimenter. J A p p l Behav Anal 5:53-64, 1972. 8. Veenstra MS: Behavior modification in the home with the mother as the experimenter: The effect of differential reinforcement on sibling negative response rates. Child Dev 42: 2079-83, 1971. 9. Patterson GR, Gullion ME: Living with Children: New Methods for Parents and Teachers. Champaign, Illinois: Research Press, 1968. 10. Patterson GR: Families: Application o f Social Learning to Family Life. Champaign, Illinois: Research Press, 1971. 11. Patterson G, McNeal S, Hawkins N, et al: Reprogramming the social environment. J Child Psychol Psychiat 8:181-95, 1967. 12. Hanf C, Kling J: Facilitating parent child interaction: A two stage training model. Unpublished manuscript, 1974. 13. Bernal M, Duryse JS, Pruett HL, et al: Behavior modification and the brat syndrome. J Consult Clin Psychol 32:447-55, 1968. 14. Bernal M: Behavioral feedback in the modification of brat behaviors. J Nerv Ment Dis 148:375-85, 1969. 15. Watzlawick P, Beavin JH, Jackson DD: Pragmatics o f Human Communication. New York, Basic Books, 1967. 16. Bronfenbrenner U: Toward a theoretical model for the analysis of parentchild relationships in a social context. In J Glidewell (Ed), Parental Attitudes and Child Behavior. Springfield, Ill, Charles C Thomas, 1961. 17. Loevinger J, Sweet B: Construction of a test of mothers' attitudes. In J Glidewell (Ed), Parental Attitudes and Child Behavior. Springfield, Ill, Charles C Thomas, 1961. 18. Hollingshead AB: Two factor index of social position. Mimeographed, 1957. 19. Wimberger HC, Gregory RJ: A behavior checklist for use in child psychiatry clinics. J A m e r Acad Child Psychiat 1:677-88, 1968.
